Acalabrutinib with bendamustine and rituximab for untreated mantle cell lymphoma [ID6155]

Lymphomas are cancers of the lymphatic system which is a part of the immune system. Lymphomas are divided into Hodgkin lymphoma and non-Hodgkin lymphoma.

Non-Hodgkin lymphomas (NHL) are a diverse group of conditions which are categorised according to the cell type affected (B-cell or T-cell) as well as the clinical features and rate of progression of the disease.

Mantle cell lymphoma is a rare and often aggressive type of NHL which affects B-cells.There are around 590 new cases of mantle cell lymphoma diagnosed in the UK each year (comprising around 5% of all non-Hodgkin lymphoma cases) *1. Mantle cell lymphoma usually occurs in older adults and is more common in men than women at a ratio of 2.4:1 *2.

Data from the UK between 2010 to 2019 indicates that the 5-yearsurvival rate is 47% *3.NICE guideline 52 (NG52) recommends the following options for first-line treatment of mantle cell lymphoma:• Chemotherapy in combination with rituximab for people with advanced stage mantle cell lymphoma who are symptomatic taking into account the persons fitness when deciding on chemotherapy intensity.Since NG52 bendamustine with rituximab is available for first-line use through an NHS England commissioning policy for treating mantle cell lymphoma.

It is an option for less fit patients as an alternative to other regimens such as rituximab with cyclophosphamide doxorubicin vincristine and prednisolone (R-CHOP) and rituximab cyclophosphamide vincristine and prednisolone (R-CVP).o NICE Technology appraisal guidance TA370 recommends bortezomib with rituximab cyclophosphamide doxorubicin and prednisone (VRCAP) as an option for previously untreated mantle cell lymphoma in adults for whom haematopoietic stem cell transplantation is unsuitable.• Cytarabine-based immunochemotherapy for people with advanced-stage mantle cell lymphoma who are fit enough to have it.• Radiotherapy for people with localised stage 1 or 2 mantle cell lymphoma.• Watch and wait for people with clinically non-progressive disease who are asymptomatic and when radiotherapy is not suitable.• Consolidation with autologous stem cell transplantation when mantle cell lymphoma has had at least a partial response to induction chemotherapy in people who are fit enough for transplantation.

Maintenance treatment withrituximab is recommended for some people with newly diagnosed mantle cell lymphoma including those who are not fit enough for high-dose chemotherapy and where there has been a response to R-CHOP (rituximab cyclophosphamide doxorubicin vincristine and prednisolone)-basedimmunochemotherapy or where there is remission after cytarabine-based induction and high-dose chemotherapy.References*1.

Haematological Malignancy Research Network (HMRN). Statistics: UK incidence. https://hmrn.org/statistics/incidence/uk. Accessed May 2024.2. Haematological Malignancy Research Network (HMRN). Statistics: QuickStats.https://hmrn.org/statistics/quickstats. Accessed May 2024.2. Haematological Malignancy Research Network (HMRN).

Statistics: Survival.https://hmrn.org/statistics/survival. Accessed May 2024.